For the columellar lengthening, the short prolabium was elevated. The medial and lateral crurae was identified and the lower lateral cartilage was reached through the incision. Through this the degloving of the nose was done. The short prolabium was used as a base for the columella lengthening. A medial and lateral osteotomy of nasal bones was performed. This ensured a narrowing of the broad nose. The broad dome was approximated with a interdomal suture.
A portion of the costochondral graft that was harvested was sculpted in to 2 pieces. The large one was used for augmenting the dorsal portion of the nose. The smaller graft was used as a sturt graft and increase the height of the nose. This was latter secured in its place and anchored to the anterior nasal spine tightly. The medial and lateral nasal crurare were approximated and sutured. An alar sinching was done to ensure a reduction in the base of the nose and secure it in its new position.
The defect in the base of the columella was corrected with a carefully planned Abbe flap, that was demarcated, raised with appropriate blood supply from lower labial vessels. This lip flap was then lip switched to the upper lip. The rich vascular base ensured proper blood supply while the vermilion border of lower lip resembles that of the upper lip. The flap was secured in layers. The result was a well formed nose that was narrow, of appropriate dimension while the lip area had normal color and appearance.